ABSTRACT
OBJECTIVE: Carotid ultrasound (US) is a screening test for patients with transient ischemic attacks (TIAs) or stroke who then undergo Digital Subtraction Angiogram (DSA) or Magnetic Resonance Angiography (MRA). Gold standard DSA is invasive with inherent risks and costs. MRA is an evolving technology. This study compares reliability of MRA and US modes with DSA in determining degree of internal carotid artery stenosis. METHODS: A five year retrospective analysis of 140 carotid arteries from patients who had carotid US and DSA, and possibly Magnetic Resonance Angiography was undertaken. Recorded US parameters were peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/CCA peak systolic velocity ratio. The MRA and DSA parameters used NASCET technique for measuring stenosis. Statistical analysis included ROC curves and Kappa computation. RESULTS: US grading of carotid stenosis can be made more reliable by choosing appropriate parameters. The best combination of sensitivity and specificity for stenosis > 70% in our hospital was seen at PSV > 173 cm/s (sensitivity 0.87, specificity 0.8, Positive Predictive Value (PPV) 0.70, Negative Predictive Value (NPV) 0.93, kappa 0.64 and weighted kappa 0.71). MRA kappa was 0.78, (sensitivity 0.75, specificity 1.0, PPV 1.0, NPV 0.85). CONCLUSIONS: US parameters should be validated in each centre. At best, US can only approximate the accuracy of DSA, probably due to inherent limitations of this modality. Magnetic Resonance Angiography has a perfect specificity and PPV but this technique needs to be standardized. Simultaneous use of MRA and US for screening increases sensitivity to over 0.9 without compromising specificity in > 70% stenosis.
Subject(s)
Angiography, Digital Subtraction , Carotid Artery, Internal , Carotid Stenosis/diagnostic imaging , Magnetic Resonance Angiography , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Stenosis/pathology , Humans , ROC Curve , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Ultrasonography , United StatesSubject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Hypopituitarism/etiology , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/secondary , Biopsy, Needle , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/therapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Diagnosis, Differential , Female , Humans , Hypopituitarism/diagnosis , Immunohistochemistry , Magnetic Resonance Imaging , Mastectomy, Radical/methods , Middle AgedSubject(s)
Muscle, Skeletal/pathology , Muscular Diseases/diagnosis , Achilles Tendon/diagnostic imaging , Achilles Tendon/pathology , Adult , Ankle/diagnostic imaging , Ankle/pathology , Ankle Joint/diagnostic imaging , Ankle Joint/pathology , Humans , Magnetic Resonance Imaging , Male , Muscle, Skeletal/diagnostic imaging , RadiographyABSTRACT
PURPOSE: The progression of synovial chondromatosis to chondrosarcoma is very rare. Distinction between these two entities may be difficult on histology alone, and should be based on clinical, radiographic and microscopic evidence. Immunohistochemical markers that would facilitate differentiation between synovial chondromatosis and chondrosarcoma are currently being investigated. PATIENTS: We describe the cases of two patients who presented with synovial chondromatosis and progression to synovial chondrosarcoma during periods of 7 and 11 years. Several biopsies and resected specimens demonstrated synovial chondromatosis before a diagnosis of chondrosarcoma was made. METHOD: We have examined five markers (Bcl2, Ki67, p27, p16, and p53) in all specimens from these cases, as well as known cases of chondromatosis and chondrosarcoma for control purposes. RESULTS: We found increased expression of Bcl2 in benign chondromatosis compared to synovial or central chondrosarcomas. DISCUSSION: Distinction between chondromatosis and its progression to low grade chondrosarcoma is difficult at histological level, and must involve incorporation of clinical and radiographical data. Although preliminary, our study suggests that reduced or absent expression of Bcl2 is associated withmalignant transformation of chondromatosis.